Temporal bone fractures

High-resolution technique is essential to the evolution of temporal bone fractures. Axial and coronal scan planes are optimal but may not be possible in acutely traumatized patients. A knowledge of normal temporal bone anatomy is important and can be obtained from standard texts, so it will not be considered in detail in this article. Classically, petrous temporal bone fractures have been classified as longitudinal, transverse, or mixed. Recent publications have emphasized the importance of describing fractures in terms of planes rather than lines. According to this concept, most temporal bone fractures are actually oblique, and true longitudinal fractures are rare. Petrous temporal bone fractures may be associated with cranial nerve or vascular injuries when the fracture extends to the skull base. This is particularly true of the oblique fracture, which characteristically extends anteromedially to the skull base through weak places in that area, thus avoiding the compact bone of the otic capsule surrounding the labyrinth. The most common associated injury is to the facial nerve in its geniculate or proximal tympanic segment. Transverse fractures frequently involve the labyrinth. A careful search for various types of ossicular dislocation should be performed in association with temporal bone fractures, because this may result in conductive hearing loss. The site of cerebrospinal fluid otorhinorrhea resulting from temporal bone fractures can usually be defined on plain high-resolution temporal bone images, but intrathecal contrast may be helpful. Temporal bone fractures caused by gunshot wounds are frequently complex and may be limited by metallic streak artifacts. Pediatric patients have different proportions of facial nerve injury and types of hearing loss as compared with adults.